ORIGINAL RESEARCH published: 23 November 2020 doi: 10.3389/fmed.2020.581248 Frontiers in Medicine | www.frontiersin.org 1 November 2020 | Volume 7 | Article 581248 Edited by: Alessia Alunno, University of Perugia, Italy Reviewed by: Cheng-De Yang, Shanghai Jiao Tong University, China Vasco C. Romão, University of Lisbon, Portugal *Correspondence: Salvatore De Vita salvatore.devita@asufc.sanita.fvg.it Specialty section: This article was submitted to Rheumatology, a section of the journal Frontiers in Medicine Received: 08 July 2020 Accepted: 21 October 2020 Published: 23 November 2020 Citation: Zabotti A, Zandonella Callegher S, Tullio A, Vukicevic A, Hocevar A, Milic V, Cafaro G, Carotti M, Delli K, De Lucia O, Ernst D, Ferro F, Gattamelata A, Germanò G, Giovannini I, Hammenfors D, Jonsson MV, Jousse-Joulin S, Macchioni P, Parisi S, Perricone C, Stradner MH, Filipovic N, Tzioufas AG, Valent F and De Vita S (2020) Salivary Gland Ultrasonography in Sjögren’s Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project. Front. Med. 7:581248. doi: 10.3389/fmed.2020.581248 Salivary Gland Ultrasonography in Sjögren’s Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project Alen Zabotti 1 , Sara Zandonella Callegher 1 , Annarita Tullio 2 , Arso Vukicevic 3,4 , Alojzija Hocevar 5 , Vera Milic 6 , Giacomo Cafaro 7 , Marina Carotti 8 , Konstantina Delli 9 , Orazio De Lucia 10 , Diana Ernst 11 , Francesco Ferro 12 , Angelica Gattamelata 13 , Giuseppe Germanò 14 , Ivan Giovannini 1 , Daniel Hammenfors 15,16 , Malin V. Jonsson 15,17 , Sandrine Jousse-Joulin 18,19 , Pierluigi Macchioni 14 , Simone Parisi 20 , Carlo Perricone 7 , Martin Helmut Stradner 21 , Nenad Filipovic 3,4 , Athanasios G. Tzioufas 22 , Francesca Valent 2 and Salvatore De Vita 1 * 1 Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy, 2 Institute of Epidemiology, Academic Hospital ’Santa Maria della Misericordia’, Udine, Italy, 3 Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia, 4 Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia, 5 Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, 6 Institute of Rheumatology, Belgrade, Serbia, 7 Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy, 8 Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy, 9 Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands, 10 Unit of Clinical Rheumatology, Department of Rheumatology and Medical Sciences, Aziende Socio Sanitarie Territoriali (ASST) Centro Traumatologico Ortopedico G. Pini-Centri Traumatologici Ortopedici (CTO), Milan, Italy, 11 Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany, 12 Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy, 13 Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Rome, Italy, 14 Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy, 15 Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway, 16 Department of Rheumatology, Haukeland University Hospital, Bergen, Norway, 17 Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway, 18 Rheumatology Department, Centre Hospitalier Universitaire (CHU) de Brest, Univ Brest, Brest, France, 19 UMR 1227, Lymphocytes B et Autoimmunité (LBAI), Inserm, Univ Brest, Brest, France, 20 Unit of Rheumatology, Department of General and Specialty Medicine, Città della Salute e della Scienza, Turin, Italy, 21 Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria, 22 Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren’s syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience. Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring. Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light’s kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability